Incidence, procedural management, and clinical outcomes of coronary in‐stent restenosis: Insights from the National VA CART Program

Catheterization and Cardiovascular Interventions - Tập 91 Số 3 - Trang 425-433 - 2018
Stephen W. Waldo1, Colin O’Donnell1, Andrew Prouse1, Mary E. Plomondon1, Sunil V. Rao2, Thomas M. Maddox1, P. Michael Ho1, Ehrin J. Armstrong1
1Department of Medicine VA Eastern Colorado Health Care System Denver Colorado
2Department of Medicine, Durham VA Medical Center, Durham, North Carolina

Tóm tắt

AbstractBackroundIn‐stent restenosis (ISR) remains a common clinical problem associated with significant morbidity. We sought to evaluate the temporal trends in incidence and procedural management of coronary restenosis as well as evaluate the association between different treatment modalities and clinical outcomes.MethodsWe identified all patients treated for coronary ISR within the Veterans Affairs Healthcare System from October 1, 2006 to September 30, 2014. The temporal trends in incidence as well as intraprocedural management were assessed. Among patients treated for single vessel restenosis, a propensity matched cohort was created for those treated with drug‐eluting stents (DES) or other treatment modalities. Target vessel revascularization (TVR) and mortality were compared between the two subpopulations.ResultsFrom 2006 to 2014, 65,443 patients underwent percutaneous coronary intervention and 6,872 patients (10.5%) with 8,921 lesions were treated for ISR. The proportion of patients undergoing revascularization for restenosis increased 0.28% per year (P = 0.055). Among a propensity‐matched cohort of 6,231, the rates of TVR (subdistribution HR: 0.623, 95% CI: 0.511–0.760) and mortality (HR: 0.730, 95% CI: 0.641–0.830) were significantly lower among patients treated with a DES compared with other treatments. After adjustment for known risk factors, treatment with DES continued to be associated with a reduction in mortality rate (Adjusted HR: 0.802, 95% CI: 0.704–0.913).ConclusionsThere is a trend toward an increasing proportion of coronary interventions for ISR in a national cohort of Veterans and treatment with a DES is associated with the lowest rate of TVR and overall mortality.

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Catheterization and Cardiovascular Interventions

Tập 91 Số 3

425-433

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